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Pharmacist saves a GP a day
9 June 2017
While working as a CCG pharmacist brought its own rewards, Yaksheeta Dave realised she missed the direct contact with patients she previously had as a community and hospital pharmacist.
“After several years as a CCG pharmacist I realised that although I was overseeing 26 GP practices for the CCG, I had almost no direct patient contact. I took the step of giving up my job at the CCG and undertook the independent prescribing course – and it’s certainly a decision that I haven’t regretted.”
When the NHS England clinical pharmacist in general practice pilot began in April 2016, Dave was already working as a GP pharmacist at two practices as part of a pilot organised by the practices themselves. One of those was Hillview Surgery, where she is now the full time clinical pharmacist.
Dave explains: “I knew Hillview through my CCG work and I had a good working relationship with them. A GP partner here was my designated medical practitioner for the independent prescribing course and I used to often sit in the practice reception seeing how things worked. This helped me to think about processes and how I could use my skills and knowledge most effectively.”
Her typical four day week includes:
- Telephone consultations with patients
- Liaising with community pharmacies and the surgery reception team
- Dealing with prescription queries
- Reconciling medication changes set out in discharge letters or outpatient clinic letters
- Face-to-face clinics for patients with long term conditions.
Clear and regular communication with local community pharmacies has been a priority and she says they work closely together to improve medicines optimisation – particularly for patients with multi-morbidity and those recently discharged from hospital.
Appropriate telephone consultations with patients are added to Dave’s list rather than that of the GP undertaking calls on a given day. She is also responsible for contacting certain patients whose blood test results have prescribing implications – such as those with a vitamin deficiency.
Within a few months of starting in the role, Dave says, one partner suggested she was reducing each of the four GPs’ workload by around an hour a day. Given the innovations introduced since, the practice suspects that figure may now be closer to two hours.
The impact on patients is anticipated to be similarly positive.
“The NHS England patient survey will help to provide quantitative data around patient satisfaction but I don’t think I’ve had any issues with the patients at all. Anecdotally, the feedback is 100% positive. I’m also a member of the patient participation group (PPG) and we regularly run themed coffee mornings at the practice. I recently organised an antibiotic awareness day with our PPG aimed at educating patients on the appropriate use of antibiotics.”
With her strong ties to the CCG, Yaksheeta leads for the practice on prescribing audits and incentive schemes, as well as promoting the CCG’s guidelines on issues such as antibiotic prescribing. She also drafts practice policies, a recent example being a policy for the management of MHRA drug safety updates from the Medicines and Healthcare products Regulatory Agency.
That CCG experience has also given her a good grasp of developments in the local health economy.
“It’s important to be aware of what’s happening with the likes of STPs (sustainability and transformation partnerships) and local enhanced services. I like to find out what’s going on across the practice as well and attend all the staff and practice meetings. It’s good to understand things from the bottom up and the partners are receptive to my suggestions and comments.”
Even as Dave’s role continues to evolve, teamwork is the name of the game.
Senior practice nurse and clinical manager Kate Steeghs says: “From a nursing point of view and as clinical manager it is great to work together with Yaksheeta to improve patient care. It’s a bonus for the nursing team to have someone to discuss medication with and quite often we each have a learning experience together.
“Yaksheeta feeds back from her study days and she often informs us about changes in guidelines. We’ve done a lot of work together on implementing changes to the management of patient care in line with national guidance. She will also slot patients in to see one of our healthcare assistants for things like blood pressure checks or to have their weight taken.
“It’s helping us to be a team rather than working in silos.”
That applies also to the reception staff. PCC has played a facilitating role as part of the NHS England programme. Dave says that this input was particularly important in a session with receptionists that helped improve their understanding of her role and wider prescribing issues.
With Dave soon to trial the triaging of acute patients, she says that such innovations provide an opportunity for reception staff to deploy their enhanced understanding of prescribing issues.
“Obviously if I am working with acute patients on certain days then I’ll have less time to be dealing with prescription queries. I want to up-skill the current staff to deal with certain prescription queries.”
If her work triaging patients goes well the practice could reduce the use of locum GPs.
Dave sees frequent contact with patients as a vital part of the practice pharmacist’s role, but warns that it may not be for everybody.
“That does come with experience but it also depends on your personality. There are lots of things that make up a consultation and there is a lot of training on patient consultations through the programme, but if you are not the sort of pharmacist who relishes patient contact then maybe you should think carefully about whether the role would suit you.
“I’ve also got the certificate and diploma in pharmacy practice which are general qualifications and in this role we are generalists. However, I do think that my experience in community and hospital pharmacy and also as a CCG pharmacist have really helped me in my current role ”
For information about PCC’s support for primary care development, contact firstname.lastname@example.org
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